Long before COVID-19 pandemic, there was the physician burnout epidemic. Burnout is often linked to despair, hopelessness and isolation, and it isn’t always easy to recognize.
“Things certainly haven’t gotten better” with burnout since the pandemic’s onset, according to Kevin Hopkins, MD, a family physician and primary care medical director for Cleveland Clinic Community Care.
Physicians can tackle burnout by setting boundaries, Dr. Hopkins said. In a presentation that was part of the AMA STEPS Forward™ webinar series, he outlined five steps to do this. The goal is to build resilience, broaden margin—the space between load and limit—and hasten recovery, said Dr. Hopkins, a senior adviser on the AMA’s practice transformation team and a pioneer in advanced models of team-based care.
Burnout is a stress reaction that is largely perpetuated by certain organizational and work cultures, said Dr. Hopkins. Prevention and mitigation often depend on organizations embracing wellness. This can take a long time.
People can look inward to help them survive—and thrive—in their current work environment, said Dr. Hopkins, an AMA member. “We can’t just wait for system change and culture change.”
Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction.
Find out how to recognize and respond to burnout in a fellow physician.
“How many of us haven’t felt bent, stretched, or compressed over the last few years?” asked Dr. Hopkins. One antidote is to develop the ability to withstand or recover quickly from difficult situations. This involves identifying, prioritizing, committing, honoring, and maintaining boundaries.
The first step is to make a list of actions that have potential to create more margin and build resilience. Prioritize: rank in order what would be the most impactful changes. Pick one to three of those items, then commit to making those changes.
Honor and respect that commitment, Dr. Hopkins emphasized. “Be firm with those boundaries.”
Learn more about Dr. Hopkins’ work with the Cleveland Clinic to overcome barriers to team-based care.
Maintain those boundaries by limiting your commitments. Give yourself permission to say “no,” he said. Schedule vacation time and personal downtime. Give yourself time to think and create. Exercise and plan date nights or meals with friends.
“Schedule anything that matters on a calendar and prioritize your to-do list,” he said. Perhaps your first priority is to get eight hours of sleep or exercise for 90 minutes a week.
Thinking about all these actions can be overwhelming. Dr. Hopkins advised picking three takeaway actions and starting one, sharing one with a colleague, and studying the third for future consideration.
“Don’t let uncertainty and fear stop you. Keep your eyes on the target and go for it,” he said.
Learn about research showing that doctors hit hardest by the pandemic are at higher risk of burnout.
Margins improve by decreasing the number of decisions per day, said Dr. Hopkins. Try to handle things only once, whether it’s a meal decision or a laboratory result at the office. “Get it out of the way and move on,” he said.
Limit daily distractions. Turn off notifications, close apps, control what’s on your desktop. And when you get home—leave work at work.
It’s OK to refocus and call a timeout, he added. Box breathing—which involves inhaling, holding breath, and exhaling on counts of four—is an excellent way to hit pause for a minute. This slows your heart rate and improves focus and decision-making, he said.
Meanwhile, organizations must do their part by valuing people and relationships and prioritizing those relationships. They should provide access to mental health services and promote activities to establish a culture of well-being, said Dr. Hopkins. Physicians can look for opportunities to lead by example, and promote positive energy, he added.
Read about the three keys to a successful peer-support program for doctors.